Acute Portal and Superior Mesenteric Vein Thrombosis with Topical Testosterone Therapy: An Adverse Drug Event Case Report

This is a case report of a 55-year-old Caucasian male prescribed topical testosterone therapy for 12 months prior to admission, when he was diagnosed with acute thrombosis in the portal vein (PVT) and superior mesenteric vein (SMV). The patient had a negative thrombophilia workup, including Factor V Leiden, Prothrombin G20210A, and JAK2 V617F mutations. There were no other pertinent laboratory markers that raised concern for the cause of thrombus. No strong familial history of venous thromboembolism (VTE) was reported during the patient’s initial workup. With this in mind, the patient’s use of topical testosterone therapy was considered the most likely risk factor for the PVT and SMV thrombus. During hospitalization, the patient was initiated on therapeutic anticoagulation with a heparin drip and discharged to home on apixaban for 3 months with extended therapy to be determined by outpatient hematologist. With no other identified VTE risk factors, probability that this patient’s VTE was attributed to testosterone was evaluated using the Naranjo scale with a calculated score of 6, which classifies the adverse reaction as “likely.” Clinicians should be aware of the possibility that topical testosterone therapy may be a risk factor for venous thrombosis in unusual sites.

Fatal superior mesenteric vein thrombosis due to acute Appendicitis in an elderly patient

Superior mesenteric vein thrombosis (SMVT) is a rare complication of acute appendicitis. It has no specific clinic manifestation. Anticoagulation, antibiotics and surgery are the main treatment pillars. We report herein a case of an 86-years-old women treated for acute appendicitis complicated with SMVT and massive pulmonary embolism.

Ectopic Variceal Bleeding From Chronic Superior Mesenteric Vein Thrombosis After Hemorrhagic Pancreatitis

Varices are a common cause of gastrointestinal bleed, but a small percentage of these bleeds are due to ectopic varices. This case presents bleeding ectopic varices in the third part of the duodenum with portal hypertension secondary to chronic superior mesenteric vein thrombosis that developed after hemorrhagic pancreatitis.